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I'm new to posting about pain, so figured this is a good place to start

I wasn't sure where to post this since I've got a hodgepodge of pain that could go in a variety of sub sections so figured I'd just start here. Will try to be informative but keep it short.

In June 2017 I started having a deep ache in my left testicle, severe lower back pain, and burning pain on the inside of my left thigh not going past the knee. This was mainly with sitting and would be relieved with standing. Moderate lower back pain is something I've dealt with on and off for the past ten years so didnt think much of it. I had a similar instance of left testicular pain with accompanying back pain in 2008 and it cleared up on its own after a few months by me just ignoring it. This time around it came on with a vengeance and I ended up going to the ER where they sent me home diagnosed with epididymitis. A couple weeks later after no relief I went to my primary who ordered a lumbar MRI. 

My MRI report is below the line at the bottom. I was told by my primary that the MRI didnt really show anything that conclusively could point to my pain as someone who has zero pain could have the same exact MRI report. After I went through a whole urology workup to rule out that as the cause, I was referred to Pain Management (PM). PM doc said same thing; that the report didnt show any serious damage that would blatantly point to my back as the problem and that my issues at 3-4, 4-5, and 5-S1 were mild at best. PM doc did a trans epidural bilat at L4-L5 with maybe 50% relief and followed it up with another a month later at just L4 with no relief. Another PM doc wanted to do facet injections in hopes of a possible ablation. Both sets of test injections gave me 80% relief of backpain but didnt touch the leg or groin pain. We followed up with bilateral L4 L5 facet ablation on Sept 28, 2018 and the back pain was reduced; and has stayed reduced by 90%. No impact on groin or leg. As much as I am grateful the back pain has been severely reduced, my leg and groin were and continue to be my chief complaint.

PM doc also did an genitofemoral nerve block and inguinal nerve with no relief. He said we can try SI joint nerve block next.

I've been doing PT for the past three months with minimal improvement. There has been slight improvement in both leg and groin pain but nowhere near being alleviated. When this all started I was unable to sleep on my left side at all and had trouble sleeping through the night. Now I'm able to sleep on my left side for a little while before pain starts and am also able to sleep through the night. I'm able to walk comfortably, drive a car, go up the stairs, pick up my baby, all with minimal discomfort. Its sitting that cause the leg and groin to co crazy so I try and avoid it. My job has been nice enough to let me work from home since this all happened. 

I've read a lot on this board over the past couple years about people going through all kinds of crazy pain so I feel bad for even complaining about mine. So my questions are these:

1: If my mild disc bulges (indicated below) were pressing on a nerve root, would the MRI report say that? Since they dont mention nerve roots does that mean nothing is pressing on them?

2: Since my pain is not debilitating as it is for so many in here, should I forget about reaching to a surgeon for an opinion (in your opinions of course)?

3. Since its been 18 months since this all started, should I assume conservative measures will not fix this or should I cling to that hope since there has been some improvement; even though small?

4. Anyone have just leg pain as their chief complaint but back pain is moderate at best?

Thank you for reading my ramblings.

Meds:

Neurontin 600MG TID - no success

Percocet 10MG as needed TID - moderate success

MS Contin 30MG BID - moderate success

NSAID - all of them; moderate success

____________________________________________________________________________________________________________________________________

There is normal lumbar lordosis. Vertebral bodies demonstrate normal height. There is mild disc desiccation and intervertebral disc space narrowing at L4-5 and L5-S1. There are small disc bulges and annular fissures at these 2 levels. There is mild retrolisthesis of L4 on L5. Marrow signal is within normal limits.

The cord demonstrates normal signal and terminates at L2. Visualized portions of the retroperitoneum are within normal limits.

T12-L1: There is no evidence for central canal or neural foraminal narrowing. 

L1-2: There is no evidence for central canal or neural foraminal narrowing. 

L2-3: There is no evidence for central canal or neural foraminal narrowing. 

L3-4: There is mild bilateral facet arthropathy. There is mild bilateral posterior osseous ridging. The central canal is patent. The neural foramen are patent bilaterally. There has been no significant change when compared to the prior examination. 

L4-5: There is grade 1 retrolisthesis of L4 on L5. There is a mild broad-based disc bulge with a small superimposed central disc protrusion and annular fissure. There is bilateral facet arthropathy and ligamentum flavum infolding. The central canal is patent. There is mild bilateral recess and neural foraminal narrowing. There has been no significant change when compared to the prior examination. 

L5-S1: There is mild disc desiccation and intervertebral disc space narrowing. There is a mild circumferential disc bulge. There is a small superimposed central disc protrusion and annular fissure. There is mild bilateral facet arthropathy. The central canal is patent. There is mild left neural foraminal narrowing. There has been no significant change when compared to the prior examination.


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1

Comments

  • I would be taking the MRI to a neurosurgeon for them to review as a primary care doctor is not a spinal specialist.

    Are you sure your epididymitis is totally resolved?

    I was in the ER in June 2017 for severe testicular pain on the right side.

    Not sure if it’s related to a disc/nerve issue or not. For me it’s been three years with no relief.

    Has the PM doctor suggested your pain generator could be coming from your hip joint?

  • Jerome001Jerome001 Cocoa Beach, FloridaPosts: 377

    I agree with L4_L5 to get to a neurosurgeon and ask him or her to read your MRI. My surgeon never looks at the radiologist's MRI report instead relying on his own education, training, and experience. I hope you find a very good neurosurgeon that can give you some answers.

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  • Thank you both for responding.

    No I haven’t gone to see a surgeon. All three pain doctors advised against it with the thinking that “surgeons are a hammer, and everything to them is a nail” and that their obvious response would be that they could correct it with surgery.

    I was only diagnosed in the ER with epididimitis but that was with them only reviewing my symptoms and no real exam since I was just on a gurney in the hallway. I went and saw two urologists who did a full blood and urine work up and ruled that out. I’m going to see another urologist on the 15th to again explore that avenue.

    I did see a neurologist who suggested that it could be a hip issue but that was as far as that went; only a suggestion. I’ll be seeing another neurologist in April to pursue that again as well.

    I guess I should go see the NS. Mainly because I’d like to hear him say I’m not a candidate since I still have so much “function”. My wife is in cardiology and is having one of the radiologists look at the MRI to answer my question on whether a nerve root is being impinged. I’m hoping that it is not since this has been almost two years and that is a long time to have nerves impinged.

    Again, thanks for responding.

    L4L5, is your testicular pain constant? Burning sharp or deep? Mine is more of a deep ache and not so much shooting or burning. Like, excuse my language, long lasting blue balls. 

  • HI BrokenBruin
    MRI's do not show everything and Primary care doctor's don't usually have the expertise to make a diagnose using one. It is excellent that you got relief from the injections you have had so many don't.
    I have dealt with Si joint pain for over four years now and leg plus groin are two of the worst pain generators.I could not even bend my leg out but after therapy with a certified therapist was improving but got sick. You say your PM doctor suggests a SI joint nerve block why? You might want to ask him or her what they think about doing the manual diagnose tests first. Just a thought but I went through many injections, therapy with no diagnose or improvement it was the manual testing that set it off where other diagnostic things showed nothing. To read some really good information on Si joint you can type it in the search box upper right hand corner. 
    I agree with the suggestions you have got see the right doctor who has the knowledge to help you out.
    I hope you find some help soon.

    Sherri

  • BrokenBruin

    Welcome to Spine-Health

    I agree with the previous posters that you need to be seeing a spine specialist, orthopedic or neurosurgeon. Experienced specialist can often times look at your scans and find things that others have missed, there are also other test that in certain circumstances be better than a MRI, such as a myelogram and EMG. Leg pain is probably more of a complaint than back pain for most lumbar patients, it usually indicates nerve entrapment, which needs to be attended to as quickly as possible, you have been basically undiagnosed for 18 months and it is time you get some answers there is still a chance that you could benefit from conservative treatments after finding exactly where the pain is coming from. Keep us posted on your progress.
    Chip 

    challenger
    Veritas-Health Moderator


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  • Thank you all for the advice. I’ve decided to follow it and have two appointments with two neurosurgeons tomorrow and an appointment with an orthopedic surgeon next week to hear what they all have to say. Fingers crossed they will tell me that conservative measures are still a possibility. 

    I keep trying to think positive and cling to the fact that my bulges are “mild” and like to refer to the definitions of mild, moderate, and severe that are often posted around here. For whatever reason, reading those over and over makes me feel better. I also like to think that since I had an mri in September 2017 and another in October 2018 and they showed no changes when compared to the previous that at least the bulges aren’t getting worse.

  • Yes a constant ache in the right side of the scrotum/testicle. 

    In my experience surgeons aren’t in a hurry to operate.

    Only the pain doctors I’ve seen have said it appears I have something surgical on my MRI.

    All three surgeons I’ve seen have said no to surgery.

    Good luck with the radiologist your wife knows looking at your MRI.

    Please keep us posted.

  • Good luck with your appointments, I think you are on the right track.

    Keep us informed.

    Chip

    challenger
    Veritas-Health Moderator


  • So I ended up seeing two neurosurgeons today at clinics on the opposite side of town. Both were very pleasant experiences and the doctors came off as very professional. 

    I went in with a summary sheet that I had prepared for them that included: chief and secondary complaints and dates on which they started. Medications both past and current. Dates of all past procedures/injections and their effectiveness if any. All conservative measures I had tried as well and their effectiveness. I also came armed with a list of questions I wanted them to answer so I wouldn’t forget anything if I started to get nervous. 

    I had this on top of my imaging cd and alll of my medical records. The summary saved them from having to spend half our visit typing on the computer or fumbling through paper. They both commented how they appreciated this and wished all patients would do this. I figured the best use of my office time was for them to be answering my direct questions rather than them fumbling to get basic info from me.

    Both doctors went over my images with me and both concluded that there was no spinal stenosis, no nerve impingement, very mild retrolithesis at L4, and no major degenerative issues. We even did some flex/extension images to confirm the mild retro. They both concluded that I was nowhere near a candidate for surgery and that the issue should be treated with conservative therapy for now. They both acknowledge that my pain could be coming from the two annular tears but both felt strongly that it might be more muscular than anything. 

    I can not tell you how refreshed I feel. This of course does not fix my pain but it gives me peace of mind that I’m in a good place and gives me strength to keep a positive attitude and continue with my stretching, pt, and medication. They did both encourage me to work on reducing my opiate intake which I plan to work on. 

    I just wanted to pass on this ray of good news. This forum has been my go to resource for information the past 18 months and I just wanted to add a positive story because sadly there are many of the opposite. I understand that’s because people who do well often move on with their lives and don’t come back here anymore. I know my journey is still ongoing as I look for continued relief but I’m grateful for everyone’s advice to seek out a professional.

  • Happy that everything turned out and you do not require surgery, that is one thing that you want to put off as long as possible.

    challenger
    Veritas-Health Moderator


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